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Can multiparametric magnetic resonance of the prostate avoid biopsies in patients with elevated PSA and surgical indication for benign prostatic enlargement?

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Abstract

Introduction

To evaluate the clinical dilemma of men with surgical indication due to benign prostatic enlargement (BPE) and concomitant elevated PSA, we analysed if multiparametric magnetic resonance imaging (mpMRI) could safely prescind the prostate biopsy.

Methods

Forty men with surgical indication due to BPE and concomitantly elevated PSA levels were prospectively enrolled and retrospectively analysed. All patients underwent 1.5 Tesla mpMRI prior to TRUS-guided biopsies. In cases where mpMRI was PIRADS 3 with focal lesions, PIRADS 4 or PIRADS 5, additional fragments were obtained with the fusion guided technique. Biopsy histopathological results were used as the standard of reference.

Two scenarios were evaluated: scenario 1, considering mpMRI PIRADS 1 and 2 as negative; and scenario 2, considering PIRADS 1, 2 and 3 as negative. Clinically significant prostate cancer (CsPCa) was defined as ISUP ≥ 2.

Results

Median age was 68 years, median PSA was 9.41 (6.40–19.54) and median prostatic volume was 116.5 cc (IQR 86.5–155).

Scenario 1 mpMRI sensitivity, specificity, PPV, NPV and accuracy for any prostate cancer on prostate biopsy was 76.9%, 63%, 50%, 85% and 67.5%. For csPCa, they were 87.5%, 59.4%, 35%, 95% and 65%, respectively, for the same measures.

Scenario 2 the sensitivity, specificity, PPV, NPV and accuracy of mpMRI for any prostate cancer on prostate biopsy was 53.8%, 96.3%, 87.5%, 81.3% and 82.5%. For csPCa, they were 75%, 93.8%, 75%, 93.8% and 90%, respectively, for the same measures.

Conclusion

Prostate mpMRI may prevent unnecessary biopsies in patients with elevated PSA and surgical indications due to BPE, given its high negative predictive value.

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Authors and Affiliations

  1. Hospital Israelita Albert Einstein, Rua Iguatemi, 192, cj. 43/44, São Paulo, SP, CEP: 01451-010, Brazil

    Marcelo Langer Wroclawski, Paulo Priante Kayano, Breno Santos Amaral, Guilherme Cayres Mariotti, Fernando Ide Yamauchi, Jonathan Doyun Cha, Arie Carneiro, Fernando Korkes, Alessandra Sousa Vitalli, Thais Caldara Mussi, Gustavo Caserta Lemos & Ronaldo Hueb Baroni

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  1. Marcelo Langer Wroclawski
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  2. Paulo Priante Kayano
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  3. Breno Santos Amaral
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  4. Guilherme Cayres Mariotti
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  5. Fernando Ide Yamauchi
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  6. Jonathan Doyun Cha
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  7. Arie Carneiro
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  9. Alessandra Sousa Vitalli
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  10. Thais Caldara Mussi
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  11. Gustavo Caserta Lemos
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Corresponding author

Correspondence to Marcelo Langer Wroclawski.

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Ethical standards

This study was approved by our local ethical committee (number 81449517.0.000.0071).

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Wroclawski, M.L., Kayano, P.P., Amaral, B.S. et al. Can multiparametric magnetic resonance of the prostate avoid biopsies in patients with elevated PSA and surgical indication for benign prostatic enlargement?. Abdom Radiol 45, 3278–3282 (2020). https://doi.org/10.1007/s00261-020-02411-y

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  • DOI: https://doi.org/10.1007/s00261-020-02411-y

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